That's the question, isn't it? Now that we know what the problem is and what kind of effects can result, what's the takeaway? That is a question that psychology is currently wrestling with. There is a dearth of research on prejudice, and a smaller but still noticeable section of research on mental health in LGBTQ+ individuals. The amount of research on types of helpful interventions we can implement is the logical next step, but psychology is only just beginning to examine what these possibilities may entail. Even so, I will try to describe what I have found to the best of my ability.
One way to help LGBTQ+ individuals would be to make healthcare more accessible and tailored towards them. Kitts (2010) found that most physicians wouldn’t ask questions about the patient’s sexuality or gender identity, and as such many LGBTQ+ patients probably feel as though they can’t bring it up themselves. However, being a gender/sexual minority does come with health risks (as we have seen), which result from minority stress. These patients may also want information about future safe sex or transitioning. Remember that in Smalley, Warren, and Barefoot’s (2016) study, many transgender individuals regularly avoided receiving medical care, which is bad because the transgender community could greatly benefit from receiving healthcare services. Kitts (2010) also stated “Eliciting or discussing such information or issues should not be ignored whether or not an adolescent is sexually active. The current findings indicate that many physicians are unlikely to continue their sexual history once an adolescent reports that he or she is not sexually active. If adolescents are not sexually active, it does not necessarily mean that they do not have sexual health-related issues, such as trying to understand and accept their sexual orientation” (pg. 741). Even worse, almost half of the healthcare providers didn’t try to alleviate the strong link between sexual identity and suicide/depression, either because they didn’t know about it, or they didn’t believe it. Most of the physicians who took the survey said that they felt that their training hadn’t prepared them to care for LGBTQ+ adolescents. How many lives could be saved, if physicians knew more about the population they were serving, and the risks that population faces? There is clearly a need for healthcare which serves LGBTQ+ individuals as LGBTQ+ individuals. Some attempt towards this has been made in research, with a study by Pachankis, Hatzenbuehler, Rendina, Safren, and Parsons (2015) which tested a new form of therapy customized to address the unique health risks of LGBTQ+ individuals- specifically, gay men. They did this by adapting a form of cognitive-behavioral therapy (CBT), which is a very common type of therapy designed to teach patients techniques which can change unhealthy thinking patterns and behaviors. On top of regular CBT, they added sections which “help participants identify minority stress experiences; track cognitive, affective, and behavioral reactions to minority stress, with a focus on avoidance reactions, including substance use and condomless anal sex; attribute distress to minority stress rather than to personal failure; and enact assertive, self-affirming behaviors for coping with minority stress in safe situations” (pg. 879). This new treatment was called ESTEEM (Effective Skills to Empower Effective Men) and it achieved something that could revolutionize healthcare: combining established interventions with elements that target minority stress specifically. They compared patients who took this treatment to patients who had normal CBT and found that there were several differences. The patients who had ESTEEM experienced a similar decrease in depression and anxiety compared to the normal CBT patients, and their decrease in alcohol use and unsafe sex was similar to other common interventions besides CBT. What this shows is that ESTEEM works, but you may be wondering what kind of benefit it has, since it performed similarly to treatments which already exist. The answer is that it can target multiple discrete problem areas simultaneously, whereas the other treatments tend to only address one thing at a time. This study’s treatment was tailored to gay men, but it is possible to adapt a treatment that could work for members of other LGBTQ+ identities, such as a transgender woman. In that case, the unique effects of sexism and anti-transgender prejudice would likely have to be accounted for.
Another way we can help relieve the LGBTQ+ community of stress is by fostering a resilience/strengths perspective. What this means is that (as mentioned above), we need research which addresses how to foster resilience in LGBTQ+ individuals. Resilience, as defined by O’Connell, Boat, and Warner (2009, pg. xxviii) is “The ability to recover from or adapt to adverse events, life changes, and life stressors.” Resilience has been found to greatly decrease the amount of distress that an LGBTQ+ individual feels as a result of minority stress, and also increase positive mental health (Watson, Morgan, & Craney, 2018). A study by Dziengel (2015) investigated resiliency and consequences LGBTQ+ individuals discovered after coming out. The people they interviewed reported that being socially involved with activism in the community and educating themselves were linked to resiliency, alongside deep connections with loved ones. They also said that having hope for themselves and their future was important. These factors make sense, but how are we supposed to develop these in LGBTQ+ patients? Asakura (2016) comes up with a social work model which is supposed to encourage resiliency, saying that LGBTQ+ youth need to be helped at multiple levels. They need to be helped as individuals, they need to be helped in the context of their general environment, and they need help to deal with effects from larger society. Many established psychological interventions only target the individual processes, so it is important that we find treatments which can address all three levels of being. Asakura (2016) also claimed that there are five ways to increase resilience in LGBTQ+ youth: “navigating safety across contexts”, “asserting personal agency”, “seeking/cultivating meaningful relationships”, “unsilencing social identities”, and “engaging in collective healing and action” (pg. 17). Through these goals, all levels at which we can impact LGBTQ+ individuals are addressed. Are there concrete ways to do these things? No, there isn’t one established treatment for each- but there are multiple things we can do which will help. For example, finding mentors for LGBT+ individuals to glean information from about their identities and the community would be a good way to build personal relationships and “unsilence” their social identities (pg. 17). Looking into how to build on LGBTQ+ individual’s strengths is the next logical step research must take.
We also need to target schools. Many LGBTQ+ youth are victimized and feel unsafe or unsupported in their education. They are more likely than heterosexual youth to get into trouble at school or feel unconnected to their school (Ueno, 2005). A study by Baams, Dubas, and van Aken (2017) found that when students received certain kinds of sexual health education, they reported being more likely to intervene if they saw an LGBTQ+ student being called slurs. For male students, taking classes on safe sex increased their chances of helping, whereas female students were more likely to help if they had taken classes on anatomy. Ueno (2005) found that LGBTQ+ students stood to gain a lot if they had another friend who was a sexual/gender minority. With that in mind, research about gay-straight alliances in schools is promising. Gay-straight alliances (GSA’s) are “groups of individuals devoted to serving the needs of LGBTQ people while working with straight allies” (McCormick, Schmidt & Clifton, 2015, pg. 71). GSA’s are helpful with healthy development of LGBTQ+ youth because they can gain a greater sense of appreciation for their school, interact with people who are open and accepting- thus forming friendships, learn to understand the individuality of others, and feel safer overall. GSA’s also help straight and cisgender students by promoting contact with the LGBTQ+ population, which may decrease their discomfort around the outgroup members and reduce prejudice (Herek, 2002a).
One thing which is repeated throughout the studies on anti-transgender prejudice is that sexism and belief in a binary gender lead to a higher likelihood of prejudice and discrimination (Anderson, 2018; Brewster,Velez, Breslow & Geiger, 2019; Norton & Herek, 2013). A good way to help decrease minority stress on transgender individuals would be to decrease these beliefs. However, this is difficult because the beliefs tend to be strongly held and difficult to change. Moreover, this problem reaches past the individual and has cultural roots, so to tackle this problem would require a multi-tiered approach similar to what Asakura (2016) proposes to increase resilience. Activism may be a good way to promote these changes on a societal level. More research is needed in techniques which can reliably decrease these attitudes.
A large problem for the LGBTQ+ community is homelessness. However, there are programs out there which can help LGBTQ+ individuals who are in need. They may help with homelessness, finding employment, continuing education, legal issues, attaining healthcare and counseling services. I did an internship at a nonprofit last year which provided these services to at-risk youth, and though it was not specifically LGBTQ+ they made efforts to partner with LGBTQ+ organizations that could help those youth. Ferguson and Macchio (2015) interviewed people who work at these social programs and tried to figure out what makes these programs successful for LGBTQ+ youth. They found that the best programs tended to have these qualities: “a) a strong reliance on clinical evidence; b) use of a trauma-informed approach; c) provision of safe, stable, and supportive housing; d) incorporation of peer providers from the LGBTQ community; and e) opportunities for reciprocal learning between LGBTQ and heterosexual RHY” (pg 676). Supporting these programs in the community, seeking them out, and volunteering for them would be a good way to ensure that LGBTQ+ homeless youth receive the help that they need.
As you can see, there are several ways that LGBTQ+ individuals can be helped- both by other LGBTQ+ individuals and cisgender/heterosexual allies. But what does being an ally mean? Why should cisgender/heterosexual people become allies? Read the other blog post in this section titled “Being an Ally” for more.
Below is a video where members of the LGBTQ+ community talk about their difficulty accessing supportive healthcare.
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